Provider Demographics
NPI:1013355411
Name:OPPENHEIM, GRACE ERIN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ERIN
Last Name:OPPENHEIM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 159TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6309
Mailing Address - Country:US
Mailing Address - Phone:425-216-0550
Mailing Address - Fax:425-216-0551
Practice Address - Street 1:3925 159TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6309
Practice Address - Country:US
Practice Address - Phone:425-216-0550
Practice Address - Fax:425-216-0551
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102878949Medicaid
PA102878949Medicaid